El paradigma de la irradiación corporal total en la leucemia linfoblástica aguda: efectividad terapéutica frente a los desafíos de toxicidad / The paradigm of total body irradiation in acute lymphoblastic leukemia: Therapeutic effectiveness against the challenges of toxicity

Introducción: La irradiación corporal total (ICT) forma parte del acondicionamiento mieloablativo del trasplante de progenitores hematopoyéticos (TPH) en hemopatías malignas. Esta terapia ha demostrado recientemente mayor supervivencia en leucemia linfoblástica aguda (LLA) frente a regímenes basados en quimioterapia. Sin embargo, los efectos secundarios son una limitación importante, especialmente en la población pediátrica.Pacientes y métodosAnalizamos retrospectivamente la supervivencia de pacientes con LLA que recibieron un TPH en un hospital terciario entre los años 1996 a 2009 (N=69 TPH en 57 pacientes). Diferenciamos una cohorte que había recibido ICT (N=44) y otra que no (N=25). Posteriormente entrevistamos a los supervivientes del grupo ICT con un mínimo de 10 años de seguimiento (N=18), preguntando acerca de la presencia de efectos secundarios.ResultadosLa supervivencia global (SG) a los 2 y 5 años fue del 79,1 y 65,2%, respectivamente para el grupo ICT y del 66,2 y 55,8% para el grupo no ICT, aunque esta diferencia no fue significativa (p=0,31). La supervivencia libre de evento (SLE) a los 2 y 5 años fue del 77,3 y 63,6%, respectivamente para el grupo ICT y del 56 y 32% para el grupo no ICT (p=0,02). La probabilidad de recidiva (PR) a los 2 años habiendo recibido ICT fue del 10% y sin haber recibido ICT del 28,6% (p=0,005). Los supervivientes que recibieron ICT desarrollaron neoplasias secundarias (39%), dislipemia (67%), alteraciones cognitivas (44%), infecciones respiratorias de repetición (39%), alteraciones tiroideas (45%), insuficiencia ovárica precoz (89%), cataratas (22%) y problemas psicológicos (44%), aunque la calidad de vida, valorada por ellos mismos, fue considerada como buena para el 83% de los encuestados.ConclusionesLos pacientes que recibieron ICT tuvieron significativamente mayor SLE y menor PR. Sin embargo, los efectos adversos son frecuentes e importantes, aunque no afectan subjetivamente a la calidad de vida. (AU)

Introduction: Total body irradiation (TBI) is part of the myeloablative conditioning for hematopoietic stem cell transplantation (HSCT) in malignant hematologic disorders. This therapy has recently shown improved survival in acute lymphoblastic leukemia (ALL) compared to chemotherapy-based regimens. However, side effects are a significant limitation, especially in the pediatric population.Patients and methodsWe retrospectively analyzed the survival of patients with ALL who underwent an HSCT at a tertiary hospital between 1996 and 2009 (N=69 HSCT in 57 patients). We differentiated a cohort that received TBI (N=44) from another that did not (N=25). Subsequently, we interviewed the survivors from the TBI group with a minimum of 10 years of follow-up (N=18), asking about the presence of side effects.ResultsThe overall survival (OS) at 2 and 5 years was 79.1% and 65.2% respectively for the TBI group and 66.2% and 55.8% for the non-TBI group, although this difference was not significant (P=.31). The event-free survival (EFS) at 2 and 5 years was 77.3% and 63.6% respectively for the TBI group and 56% and 32% for the non-TBI group (P=.02). The probability of relapse (PR) at 2 years for those who received TBI was 10% compared to 28.6% for those who did not receive TBI (P=.005). Survivors who received TBI developed secondary neoplasms (39%), dyslipidemia (67%), cognitive impairments affecting memory (44%), recurrent respiratory infections (39%), thyroid abnormalities (45%), premature ovarian failure (89%), cataracts (22%), and psychological problems (44%). However, the quality of life, as self-assessed by the patients, was considered good for 83% of the participants.ConclusionsPatients who received TBI had significantly higher EFS and lower PR. However, adverse effects are frequent and significant, although they do not subjectively affect quality of life. (AU)

Efectos secundarios oculares de las terapias oncológicas. Revisión / Ocular side effects of oncological therapies: Review

Con el avance de la terapia contra el cáncer en los últimos años, ha aumentado el conocimiento de los mecanismos involucrados en esta enfermedad, lo que ha supuesto un aumento de la calidad de vida y de la supervivencia de los pacientes con afecciones tumorales anteriormente consideradas incurables o refractarias al tratamiento. El número de fármacos utilizados ha sufrido un aumento exponencial, y a pesar de que la toxicidad implícita es menor que la de la terapia antineoplásica convencional, conllevan la aparición de nuevos efectos adversos asociados, que el oftalmólogo debe reconocer y manejar.(AU)

With the advance of cancer therapy in recent years, the knowledge of the mechanisms involved in this disease has increased, which has meant an increase in the quality of life and survival of patients with tumor pathologies previously considered incurable or refractory to treatment. The number of drugs used has increased exponentially in number, and although the implicit toxicity is lower than that of conventional antineoplastic therapy, they lead to the appearance of new associated adverse effects that the ophthalmologist must recognize and manage.(AU)

Quality of life and functional outcomes in tongue cancer patients: a long-term, prospective, comparative study

Background: The tongue has an indispensable role in communication, swallowing and breathing. Tongue cancer treatment involves direct resection of the tumor and surrounding tissue, which can limit many essential functions of the tongue. There are few patient-reported quality of life studies involving tongue cancer exclusively. There is also a lack of data on the outcomes of quality of life regarding different reconstructive methods, adjuvant nonsurgical therapies and other predicting factors. Our objective is to assess the quality of life, functional status, and predicting factors in patients with tongue cancer up to one year after surgical resection. Material and Methods: Thirty-six patients with tongue cancer were prospectively identified between October of 2017 and January 2021. Patients were examined before and one, three, six and twelve months after surgical resection with the validated University of Washington Quality of Life questionnaire (UW-QOL). Data collection included patient age, sex, TNM staging, size of resection, neck dissection, tracheostomy, reconstructive method and adjuvant therapies. Outcome scores were compared using the Friedman test. Multiple linear regression analysis was used to identify the predictors of quality of life and functional status. Results: The use of UWQOL scores as dependent variables revealed the following predicting factors: age, tobacco use, radiotherapy, chemotherapy, reconstruction method and neck dissection. Conclusions: The most relevant findings in our study are that flap reconstruction becomes increasingly necessary when a glossectomy resection is over 45 mm, in order to maintain tongue function. We established that the reconstructive flap type does not influence quality of life in the long term. Also, we have found that cervical sentinel node biopsy provides better quality of life over neck dissection in the first 3 months after surgery. (AU)

Risk factors for oral mucositis in patients with solid tumorsunder treatment with cetuximab: a retrospective cross-sectional study

Background: This study retrospectively analyzed the risk factors for oral mucositis (OM) during cetuximab treatment. Material and Methods: We screened patients using cetuximab and retrospectively evaluated the presence of OM based on medical records. We collected information from 2 years of evaluations. Patient medical records were reviewed to obtain data on chemotherapy cycle and dose, sex, age, primary tumor, TNM stage, and head and neck radiotherapy (HNR) history. The X2 test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p < 0.05). Results: Among 1831 patients, OM was showed in 750 in any grade (41%), during cetuximab treatment. Most patients were female (n=944, 51.6%), <70years-old (n=1149, 62.8%), had larynx cancer (n=789, 43.1%) in T4 (n=579, 47.7%), N0 (n=509, 52.6%) stages. Primary tumor surgery was performed in 1476 (80.6%) patients, radiotherapy in 606 (33.1%) patients and cetuximab protocols most used involved up to four cycles (n=1072, 58.5%) of <400mg (n=996, 54.4%) cetuximab doses. Female (OR [odds ratio] = 2.17, CI95% = 1.26-3.75), >70 years-old patients (OR = 16.02, CI95% = 11.99-21.41), with HHNR (OR = 1.84, 1.41-2.40), treated with >4 cycles (OR = 1.52, CI95% = 1.16-2.01) and high doses of cetuximab (OR = 3.80, CI95% = 2.52-5.71) are the greatest risk factors for OM. Conclusions: Since the clinical benefit of cetuximab in the treatment of older patients is limited and there is a high OM, especially in women with head and neck treated with radiotherapy, high doses and a high number of cetuximab cycles must be administered with caution. (AU)

Correlation of Plasma and Salivary Osteocalcin Levels with Nascent Metabolic Syndrome Components with and Without Pre/Diabetes Biochemical Parameters / Correlación de los niveles de osteocalcina en plasma y saliva con los componentes del síndrome metabólico naciente con y sin parámetros bioquímicos de prediabetes

Objectives: This study aimed to compare and correlate plasma and salivary levels of cardiometabolic risk biomarkers’ of pharmacotherapy (appraised using colorimetric assays), adiposity, and atherogenicity indices. Methods: 61 Nascent MetS subjects vs. 30 lean normoglycemic and healthy controls were recruited in Family Medicine outpatient clinics/Jordan University Hospital (a referral medical center). Fasting blood and saliva specimens were collected. Clinical and anthropometric variables were determined along with atherogenecity and adiposity indices. Results: Among nascent MetS (metabolic syndrome) recruits, almost half were normoglycemic, 43% were prediabetic and 8% were diabetic. Pronouncedly Glycemic (FPG and Alc) and lipid parameters (TG, HDL-C and non-HDL-C), adiposity indices (BMI, WHR, WtHR, Conicity-index, BAI, LAP, VAI) and atherogenicity indices (AIP, TC/HDL-C, LDL-C/HDL-C, non-HDL-C/HDL-C and TG/HDL-C) were higher in the nascent MetS group (P<0.05 vs. controls). Markedly among the plasma cardiometabolic risk biomarkers (P<0.05 vs. controls) in the nascent MetS group, adipolin, cathepsin S, ghrelin, irisin, LBP, leptin, and osteocalcin were higher but plasma FGF1 levels were oddly lower. Significantly (P<0.05 vs. controls) nascent MetS –linked salivary levels of adipolin and LBP were higher as opposed to the lower cathepsin S. Only osteocalcin, amongst 9 metabolic risk biomarkers studied, had remarkably significant correlation between plasma and saliva levels, in both total sample and MetS patients (P<0.05). Markedly in the nascent MetS only group, both plasma and salivary osteocalcin correlated with FPG and A1c (P<0.05); salivary osteocalcin correlated with BMI and LAP (P<0.05). Likewise, in the total sample plasma osteocalcin correlated significantly with BMI, BAI, WHt R, SBP, DBP, TG, LAP, VAI, TG/HDL-C and AIP (P<0.05), while salivary osteocalcin had substantial correlations only with FPG and A1c (P<0.05). Conclusion: Association of nascent MetS-related plasma and salivary osteocalcin levels and clinical characteristics and indices propagate salivary osteocalcin as a non-invasive marker for clinical control of MetS-/preDM.(AU)

The extent of awareness of southern Jordanian people to thedifference between venous thrombosis and arterial thrombosis / El grado de concienciación de los habitantes del sur de Jordania sobre la diferencia entre trombosis venosa y trombosis arterial

Objective: Venous thrombosis (VTE) and arterial thrombosis are two different diseases. Although they differ in causes, types, and treatment, they share many risk factors. Many people are not able to differentiate between them. So assessing the awareness of people toward these two diseases and determining the variables that affect their awareness was the aim of the study. Methods: This is a cross-sectional validated questionnaire which was conducted on social media. It targeted the southern Jordanian public above 18 years between October and December 2022. Results: A total of 630 people participated in the current study. Only 42.2% knew the cause of arterial thrombosis compared to 58.7% in case of venous thrombosis. More than half (63.2%) of the participants knew that there is a difference between venous and arterial thrombosis. DVT (36.8%) and PE (23%) were correctly identified as types of VTE, while only myocardial infarction was identified as a type of arterial thrombosis by 52.2% of respondents. About 69.5% and 80.2% of respondents think that venous and arterial thrombosis are fatal, respectively. Regarding the socio-demographic variables that affect the awareness of the public, old age, high educational level, working, and earning at least 500 JD per month were significantly associated with better awareness of the study population about venous and arterial thrombosis with a p-value of 0.0027, < 0.001, 0.0017, and < 0.001 respectively. Conclusion: The current study reveals that there is a lack of awareness about VTE and arterial thrombosis and the difference between them among the southern Jordanian public. VTE and arterial thrombosis are preventable diseases, so more attention should be given by increasing the educational campaign and the initiatives of public health about the difference between them in terms of signs and symptoms, risk factors, and complications.(AU)

Evidence on the use of alternative substances and therapies in hypertension / Evidencias sobre el uso de sustancias y terapias alternativas en hipertensión

Objective: Review of some of the best-known biological and non-biological complementary/alternative therapies/medicines (CAM) and their relationship with blood pressure (BP) and hypertension (HT). Search strategy: Narrative review assessing a recent series of systematic reviews, meta-analyses, and clinical trials published in recent years, focusing on the effects of CAM on BP and HT. Selection of studies: We searched EMBASE, MEDLINE, Cochrane Library and Google Scholar, obtaining a total of 4336 articles, finally limiting the search to 181 after applying filters. Synthesis of results: Some studies on biological therapies show some usefulness in BP reduction with an adequate benefit–risk balance, although there is a scarcity of high-quality trials that support these results. Some mind-body therapies have shown hypothetical benefit; in contrast, others lack robust evidence. Conclusions: Although some therapies present a reasonable risk–benefit ratio, they should in no case replace pharmacological treatment when indicated.(AU)

Objetivo: Revisar algunas de las más conocidas terapias/medicinas biológicas y no biológicas complementarias/alternativas (MCA), y su relación con la presión arterial (PA) e hipertensión arterial (HTA). Estrategia de búsqueda: Revisión narrativa en la que se valoraron una serie reciente de revisiones sistemáticas, metaanálisis y ensayos clínicos publicados en los últimos años, centrada en los efectos de la MCA sobre la PA y HTA. Selección de estudios: Se realizaron búsquedas en EMBASE, MEDLINE, Cochrane Library y Google Scholar, obteniéndose un total de 4.336 artículos, limitándose finalmente a 181 tras aplicar filtros. Síntesis de resultados: Algunos trabajos sobre terapias biológicas parecen demostrar cierta utilidad en reducción de la PA con adecuado balance beneficio/riesgo, aunque existe escasez de ensayos de alta calidad que avalen estos resultados. Algunas terapias cuerpo/mente han mostrado un hipotético beneficio; en cambio, otras carecen de evidencia robusta. Conclusiones: Aunque algunas terapias presentan una relación riesgo/beneficio razonable, no deberían sustituir en ningún caso al tratamiento farmacológico cuando este esté indicado.(AU)

Clinical value and mechanistic analysis of HIIT on modulating risk and symptoms of depression: A systematic review / Valor clínico y análisis mecanicista del HIIT sobre la modulación del riesgo y los síntomas de la depresión: una revisión sistemática

Background: The exact causal mechanisms of depression remain unclear due to the complexity of the triggers, which has led to limitations in treating depression using modern drugs. High-intensity interval training (HIIT) is as effective as medication in treating depression without toxic side effects. Typically, HIIT requires less time commitment (i.e., shorter exercise duration) and exhibits pronounced benefits on depressive symptoms than other forms of physical exercise. This review summarizes the risk reduction and clinical effects of HIIT for depression and discusses the underlying mechanisms, providing a theoretical basis for utilizing HIIT in treating depression. Methods: A database search was conducted in PubMed, Embase, Web of Science, and Scopus from inception up to October 2022. The methodological quality of the included literature was evaluated by the physiotherapy evidence database (PEDro) scale criteria. The review focused on evaluating the changes in depression risk or symptoms of HIIT interventions in healthy individuals, patients with depression, and patients with other disorders co-morbid with depression. Consequently, the mechanisms associated with depression related HIIT were summarized. Results: A total of 586 participants (52 % female; mean age: 43.58±8.93 years) from 22 studies were included. Implementing HIIT using different exercise types alleviates depressive symptoms in individuals with depression and in individuals with depression who have exhibited comorbidities and reduced depression scale scores in subjects immediately after acute exercise. In addition, the long-interval HIIT and short-interval HIIT in the treatment of patients with cardiovascular or psychiatric disorders may reduce depressive symptoms via complex exercise-related changes on several levels, including by effecting the following measures: releasing monoamines, reducing neuronal death, inducing neurogenesis, modulating the functional...(AU)

The dietary risk factors on cancer patients receiving chemotherapy and correlation between serum vitamin D and b12 levels, depression and anxiety status / Factores de riesgo dietéticos en pacientes con cáncer que reciben quimioterapia y relación entre los niveles séricos de vitamina D y B12 y la depresión y la ansiedad

Objective: the aim of this study is to evaluate the relationship between serum vitamin D and B12 levels, nutritional levels, depression, and anxiety in adult cancer patients before and after chemotherapy. Methods: a case-controlled study was carried out on 44 patients who were diagnosed with cancer and applied to the Chemotherapy Unit for treatment (patient group, PG) and 44 volunteer individuals (control group, CG) with similar characteristics to the age and gender-matched patient group but with no diagnosis of cancer. Results: the average age of individuals in PG is 52.50 ± 12.21 years and for those in CG is 52.84 ± 10.98 years. Serum D and B12 levels in the first cure in individuals in PG are higher than in the last treatment (p > 0.05). It was determined that vitamin C taken with a daily diet reduces the risk of cancer (OR: 0.920, 95 % CI: 0.899-0.942, p = 0.042). No correlation was found between depression and anxiety scores of both groups and serum vitamin D and B12 levels (p > 0.05). It was determined that the Beck Anxiety Inventory (BAI) score increased with decrease in body mass index (BMI) (β = 0.311, p = 0.040) and serum vitamin B12 level (β = -0.406, p = 0.006). In addition, it was found that the increase in the Patient-Generated Subjective Global Assessment (PG-SGA) score, which reflects the nutritional status of cancer patients, worsened the level of anxiety (β = 0.389, p = 0.009). Conclusions: as stated in the findings of the study, chemotherapy treatment mediated the development of anxiety in cancer patients by changing the vitamin B12 levels and anthropometric characteristics with its negative effect on nutritional status. It should be ensured that cancer patients treated with chemotherapy follow a healthy and balanced diet plan that is suitable for their needs and has adequate vitamin and mineral content.(AU)

Objetivo: el objetivo de este estudio es evaluar la relación entre los niveles séricos de vitamina D y B12, el estado nutricional y el estado de depresión y de ansiedad antes y después de la quimioterapia en pacientes adultos con cáncer que están recibiendo quimioterapia. Métodos: se realizó un estudio de casos controlados en 44 pacientes diagnosticados de cáncer (grupo de pacientes, GP) que solicitaron tratamiento a la Unidad de Quimioterapia y 44 voluntarios sanos (grupo de control, GC) sin diagnóstico de cáncer y que tenían características similares al grupo GP en cuanto a edad y sexo. Resultados: la edad media de los individuos del GP fue de 52,50 ± 12,21 años, mientras que la del GC fue de 52,84 ± 10,98 años. Los niveles séricos de vitamina D y B12 en individuos del GP en el primer ciclo fueron más altos que en el último ciclo (p > 0,05). Se determinó que la vitamina C tomada en la dieta diaria reduce el riesgo de cáncer (OR: 0,920, IC del 95 %: 0,899-0,942, p = 0,042). No se detectó una correlación entre las puntuaciones de depresión y ansiedad de ambos grupos y los niveles séricos de vitamina D y B12 (p > 0,05). Se determinó que la puntuación Inventario de Ansiedad de Beck (BAI) aumentó con la disminución del índice de masa corporal (IMC) (β = 0,311, p = 0,040) y el nivel sérico de vitamina B12 (β = -0,406, p = 0,006). Además, se objetivó que el aumento en la puntuación en el Patient-Generated Subjective Global Assessment (PG-SGA), que refleja el estado nutricional de los pacientes con cáncer, empeoró el nivel de ansiedad (β = 0,389, p = 0,009). Conclusión: como se indica en los hallazgos del estudio, el tratamiento con quimioterapia medió en el desarrollo de ansiedad en pacientes con cáncer al cambiar los niveles de vitamina B12 y las características antropométricas con su efecto negativo en el estado nutricional...(AU)

Transcription elongation mechanisms of RNA polymerases I, II, and III and their therapeutic implications.

Transcription is a tightly regulated, complex, and essential cellular process in all living organisms. Transcription is comprised of three steps, transcription initiation, elongation, and termination. The distinct transcription initiation and termination mechanisms of eukaryotic RNA polymerases I, II, and III (Pols I, II, and III) have long been appreciated. Recent methodological advances have empowered high-resolution investigations of the Pols' transcription elongation mechanisms. Here, we review the kinetic similarities and differences in the individual steps of Pol I-, II-, and III-catalyzed transcription elongation, including NTP binding, bond formation, pyrophosphate release, and translocation. This review serves as an important summation of Saccharomyces cerevisiae (yeast) Pol I, II, and III kinetic investigations which reveal that transcription elongation by the Pols is governed by distinct mechanisms. Further, these studies illustrate how basic, biochemical investigations of the Pols can empower the development of chemotherapeutic compounds.

DERL2 (derlin 2) stabilizes BAG6 (BAG cochaperone 6) in chemotherapy resistance of cholangiocarcinoma

DERL2 (derlin 2) is a critical component of the endoplasmic reticulum quality control pathway system whose mutations play an important role in carcinogenesis, including cholangiocarcinoma (CHOL). However, its role and its underlying mechanism have yet to be elucidated. Herein, we revealed that DERL2 was highly expressed in CHOL and considered as an independent prognostic indicator for inferior survival in CHOL. DERL2 ectopically expressed in CHOL cells promoted cell proliferation and colony formation rates, and depleting DERL2 in CHOL cells curbed tumor growth in vitro and in vivo. More interestingly, the knockout of DERL2 augmented the growth-inhibitory effect of gemcitabine chemotherapy on CHOL cells by inducing cell apoptosis. Mechanistically, we discovered that DERL2 interacted with BAG6 (BAG cochaperone 6), thereby extending its half-life and reinforcing the oncogenic role of BAG6 in CHOL progression. (AU)

DERL2 (derlin 2) stabilizes BAG6 (BAG cochaperone 6) in chemotherapy resistance of cholangiocarcinoma

DERL2 (derlin 2) is a critical component of the endoplasmic reticulum quality control pathway system whose mutations play an important role in carcinogenesis, including cholangiocarcinoma (CHOL). However, its role and its underlying mechanism have yet to be elucidated. Herein, we revealed that DERL2 was highly expressed in CHOL and considered as an independent prognostic indicator for inferior survival in CHOL. DERL2 ectopically expressed in CHOL cells promoted cell proliferation and colony formation rates, and depleting DERL2 in CHOL cells curbed tumor growth in vitro and in vivo. More interestingly, the knockout of DERL2 augmented the growth-inhibitory effect of gemcitabine chemotherapy on CHOL cells by inducing cell apoptosis. Mechanistically, we discovered that DERL2 interacted with BAG6 (BAG cochaperone 6), thereby extending its half-life and reinforcing the oncogenic role of BAG6 in CHOL progression. (AU)

Obstacles in combating multidrug resistant tuberculosis in pediatric patients: a scope review / Obstáculos no combate à tuberculose multidroga resistente em pacientes pediátricos: uma revisão de escopo

Abstract Objectives: to identify the scientific evidence on excessively resistant and multidrug resistant tuberculosis in pediatric patients. Methods: this is a scope review of the literature, with a guiding question: "What is the scientific evidence on multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis in pediatric patients?". The research used the descriptors: "extensively drug-resistant tuberculosis" OR "multidrug-resistant tuberculosis" AND "pediatrics". The research was carried out in a double-blind manner in the following databases of the Medical Literature Analysis and Retrieval System Online, Regional Office for the Western Pacific's Institutional Repository for Information Sharing, Embase/Elsevier and International Clinical Trials Registry Platform, with a temporal cut-off from 2011 to 2021, sending a final synthesized sample of 18 articles, which evaluated the methodological content through the level of evidence. Results: the results show the lack of research with a high level of evidence related to MDR-TB in children, the lack of adequate dosage of second-line drugs for the pediatric population and the importance of drug sensitivity testing for the cases of treatment Conclusions: it was identified that the obstacles to MDR-TB treatment were concentrated in the lack of detailed protocols, safe drug dosages with a low side effect, and mainly in the social health determinants and disease process involving MDR-TB.

Resumo Objetivos: identificar as evidências científicas sobre tuberculose excessivamente resistente e multidroga resistente em pacientes pediátricos. Métodos: trata-se de uma revisão de escopo da literatura, tendo como questão norteadora: "Quais as evidências científicas sobre tuberculose multidroga-resistente (TB-MDR) e tuberculose extensivamente resistente em pacientes pediátricos?" A pesquisa usou os descritores: "tuberculose extensivamente resistente a medicamentos" OR "tuberculose resistente a múltiplos medicamentos" AND "pediatria". A pesquisa foi realizada de modo duplo-cego nas bases de dados Medical Literature Analysis and Retrieval System Online, Regional Office for the Western Pacific's Institutional Repository for Information Sharing, Embase/Elsevier e International Clinical Trials Registry Platform, com um corte temporal de 2011 a 2021, sendo a amostra final sintetizada de 18 artigos, nos quais avaliou-se o conteúdo metodológico por meio do nível de evidência. Resultados: os resultados mostraram a escassez de pesquisas de alto nível de evidência relacionadas à TB-MDR em crianças, ausência de posologia adequada das drogas de segunda linha para o público pediátrico e a importância do teste de sensibilidade a drogas para o tratamento dos casos. Conclusões: identificou-se que os obstáculos do tratamento TB-MDR se concentraram na ausência de protocolos detalhados, de dosagens medicamentosas seguras e com menor efeito colateral, e, principalmente, nos determinantes sociais do processo saúde e doença que envolvem a TB-MDR.

Secondary sclerosing cholangitis induced by systemic chemotherapy

There are multiple causes of secondary sclerosing cholangitis (SSC), including mechanical obstruction, ischemia, congenital abnormalities, cholangiopathy of the critically ill patient and rarely, chemotherapy (1,2). We present the case of a 52-year-old female with a history of left breast invasive ductal carcinoma treated with neoadjuvant chemotherapy (adriamycin, cyclophosphamide and paclitaxel), surgery and radiotherapy in March 2021. She was admitted in July 2022 due to painless jaundice and pruritus with marked serum cholestasis. Magnetic resonance cholangiopancreatography showed multiple strictures and dilatations involving the intra and extrahepatic bile ducts (Figure 1.A), without any extrinsic stenotic cause. Findings were confirmed by endoscopic retrograde cholangiopancreatography (ERCP) with cholangioscopy (Figure 1.B). Biopsies were negative for malignancy and IgG4 disease. In addition, autoantibodies were negative and serum IgG4 levels were normal. Due to these findings and the history of recent chemotherapy, the patient was diagnosed with paclitaxel-induced sclerosing cholangitis, initiating treatment with ursodeoxycholic acid. Over the following two months, she suffered two episodes of Klebsiella Pneumoniae bacteraemia due to acute cholangitis. Dilatation and placement of plastic stents in both biliary trees were performed and prophylactic antibiotherapy was started. The patient had a poor evolution and was not candidate for liver transplantation on account of a recent neoplasia. She died six months later due to sepsis secondary to multiple hepatic abscesses. (AU)

Uso seguro de medicações: necessidades de aprendizagem e potencialidades para ensino mediado por tecnologias virtuais / Safe use of medications: learning needs and strengths for teaching mediated by virtual technologies

Objetivo: Identificar as necessidades de aprendizagem de graduandos de enfermagem sobre segurança do paciente e segurança medicamentosa. Métodos: Estudo descritivo, transversal, desenvolvido no período de março de 2019 a dezembro de 2020, com amostra não probabilística e intencional constituída por 45 graduandos de enfermagem. Os dados foram analisados por meio de estatística descritiva. Resultados: Houve predomínio de estudantes do sexo feminino (73,3%) com renda familiar entre 1 e 2 salários mínimos. Todos confirmaram ter acesso à internet, com frequência diária de uso de participantes (93,3%). O smartfone foi o aparelho mais utilizado para acesso à internet (77,8%), tendo o domicílio como local predominante de acesso (80,0%). Sobre as necessidades de aprendizagem acerca da segurança do paciente e da segurança medicamentosa, destacou-se a classificação "essencial" dentre as questões avaliadas. Conclusão: Identificaram-se como as principais necessidades de aprendizagem dos participantes: atuar em equipe de forma eficaz, compreender os sistemas e o efeito da complexidade dos cuidados ao paciente e definição dos conceitos-chaves. Junto a isso, verificaram-se fragilidades de diferenciação entre os termos comuns no processo de administração de medicamentos. Descritores: Educação em Enfermagem; Segurança do Paciente; Tratamento Farmacológico; Tecnologia.

Objective: To identify the learning needs of undergraduate nursing students about patient safety and medication safety.Methods: Descriptive and cross-sectional study, developed from March 2019 to December 2020, with a non-probabilistic and intentional sample consisting of 45 undergraduate nursing students. Data were analyzed using descriptive statistics.Results: There was a predominance of female students (73.3%) with family income between 1 and 2 minimum wages. All confirmed having access to the internet, with a daily frequency of use by participants (93.3%). The smartphone was the most used device to access the internet (77.8%), with the home being the predominant place of access (80.0%). Regarding the learning needs about patient safety and medication safety, the classification "essential" stood out among the evaluated questions.Conclusion:The main identified learning needs of the participants were: working effectively as part of a team, understanding the systems and the effect of the complexity of patient care and defining the key concepts. In addition to that, there were weaknesses in differentiating between common terms in the medication administration process. Descriptors: Education, Nursing; Patient Safety; Drug Therapy; Technology.